A $16 billion effort to give veterans lifetime electronic health records that meshed with the Pentagon's has been marked by repeated delays and oversight failures that could have put patients at risk, according to reports from the VA Inspector General.
The IG reports released Monday detailed confusion in the overall implementation of the plan and failures to train staff and put in place adequate equipment for the pilot program, such as new laptops.
The first IG report, titled "Deficiencies in Infrastructure Readiness for Deploying VA's New Electronic Health Record [EHR] System," looked at how the Department of Veterans Affairs went about implementing the initial $10 billion, 10-year contract with Cerner Corp. of Kansas.
The VA now estimates that the contract, awarded in May 2018 by then-Acting VA Secretary Robert Wilkie without competitive bidding, will now cost at least another $6 billion for management and equipment.
The second report focused on delays and failures in the pilot program, even after it was scaled back from three test sites to one at the Mann-Grandstaff VA Medical Center (VAMC) in Spokane, Washington.
One of the main findings of the second report was that patient safety at the Spokane facility could have been put at risk due to poor preparation for the planned switchover to the Cerner system in the pilot program.
The IG's report found that the VA and the Spokane leadership failed to hire and train adequate staff to handle the transition, and overlooked the impact on how the hospital would continue to function while the inevitable kinks in the system were worked out.
"For example, online prescription refills, the most popular form for refilling prescriptions at the facility, was identified as a capability that would be absent when going live," the IG's report said of the pilot program at the Mann-Grandstaff VAMC. "The OIG determined that the multiple work-arounds needed to address the removal of an online prescription refill process presents a patient safety risk."
In addition, the IG found that the VA's expanded program to allow veterans to choose community care -- made policy by the Mission Act of 2018 -- had suffered as the Spokane facility focused on the switchover to EHR.
"The OIG identified that facility leaders addressed recent in-house access to care challenges within primary care, but a significant backlog of 21,155 care in the community consults remained as of January 9, 2020," the report said.
Outrage on the Hill
In May 2019, VA Secretary Robert Wilkie identified the transition to EHR as one of his top priorities, noting its potential "to change the way our veterans are treated, but also change the way we do business, to make the delivery of our services more efficient, make it more timely."
In that same month, then-acting Defense Secretary Patrick Shanahan took a beating during a hearing of the House Defense Appropriations Subcommittee when he projected a possible four-year delay in implementing the transition.
"I don't ever recall being as outraged about an issue than I am about the electronic health record program," Rep. Kay Granger, R-Texas, told Shanahan.
"For 10 years we've heard the same assurances" that the electronic health records problem will be solved, Rep. Hal Rogers, R-Kentucky, said. "It's incredible that we can't get this fixed."
Veterans were suffering "because of bureaucratic crap," he added.
Over the years, previous attempts to mesh the EHR systems of the VA and DoD have either failed or been abandoned, most recently in 2013 when then-Defense Secretary Leon Panetta and then-VA Secretary Eric Shinseki dropped an integration plan after a four-year effort and about $1 billion spent.
The goal of the new effort to integrate the records was to overcome the track record of failure by the VA and the DoD to meet a congressional mandate to bring their separate medical records systems in line with one another, ensuring a seamless transition for service members to civilian life.
In its overview of the VA's latest attempt, the IG report noted that "there are tremendous costs and challenges associated with this effort."
Under the current plan the VA's legacy information system -- Veterans Information Systems and Technology Architecture (VistA) -- would be replaced by Cerner's commercial off-the-shelf solution called "Millennium."
The plan was to have VA's Millenium mesh with DoD's electronic health record system -- Military Health System (MHS) GENESIS -- which at its core also consists of Cerner's Millennium, the IG report said.
The ultimate connection of VA and DoD's electronic health records "will result in a comprehensive, lifetime health record for service members," the report said, improving health outcomes by giving providers more complete information.
However, the indefinite hold put on the pilot program in Spokane underlines the huge challenges ahead in implementing the transition as the nation seeks to recover from the coronavirus pandemic, the IG said.
The report found widespread failure in VA's preparations to start up the new system in Spokane.
"The lack of important upgrades jeopardizes VA's ability to properly deploy the new electronic health record system and increases risks of delays to the overall schedule," the report said. "Until modifications are complete, many aspects of the physical infrastructure existing in the telecommunications rooms [such as cabling] and data center do not meet national industry standards or VA's internal requirements."
The VA's response essentially concurred with the findings and recommendations of the IG's overview and the separate report on the pilot program in Spokane.
In his response, Dr. Richard Stone, executive in charge of the Veterans Health Administration, said that the VA was working to correct the problems with infrastructure and staffing noted by the IG.
"I appreciate the concerns regarding mitigation strategies and capabilities of the new electronic health records [EHR] system," Stone said.
He said that as the target date was approaching for the launch of the pilot program in Spokane, "Secretary Wilkie received feedback from clinical and technical staff."
"He decided to postpone the Go-Live so that the system can provide the greatest functionality at Go-Live and VHA staff are confident in providing care with the new system with the least mitigation strategies," Stone said.
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